CT血管成像对破裂性颅内动脉瘤所致的脑内血肿手术的应用价值

Applicative value of CT angiography in emergent operation for ruptured intracranial aneurysm caused intracerebral hematoma

目的探讨多层螺旋CT血管成像(MSCTA)检查在急性破裂性颅内动脉瘤所致的脑内血肿显微外科于术治疗中的应用价值。方法回顾性分析破裂性颅内动脉瘤导致的脑内血肿,术前头部CTA检查后行急诊手术治疗的15例患者的影像学和临床资料,根据CTA不同成像技术显示的检查结果确定手术方案,选择手术入路,行急诊血肿清除术并行动脉瘤夹闭术,对CTA在手术中的应用价值进行分析。结果 15例患者在术中均被证实为动脉瘤,与头部CTA术前诊断位置基本一致,动脉瘤的大小、生长方向与术前判断的方向基本一致,所有的动脉瘤均予夹闭,采用格拉斯哥预后评分(GOS)评估患者的预后,所有患者均门诊和(或)电话随访6～78个月,平均随访时间为24个月。GOS 2分为2例;GOS 3分为2例;GOS 4分为6例;GOS 5分为5例。结论头部CTA检查能简便、快速地明确脑动脉瘤破裂出血引起的自发性脑内血肿,可提供直观的三维形态及解剖定位,有利于急诊手术清除血肿及夹闭动脉瘤,对急诊开颅手术治疗具有重要的指导价值。

Objective To investigate the applicative value of muhislice spiral computed tomography angiography （MSCTA） in the microsurgery of ruptured intracranial aneurysm caused acute intracerebral hematoma. Methods The imaging and clinical data of 15 patients with ruptured intracranial aneurysm caused intracerebral hematomas, whom underwent emergency surgery after preoperative CT angiography （CTA） were analyzed retrospectively. The surgical plan was determined according to the CTA imaging resuits. The hematomas were evacuated and the aneurysm were clipped. The applicative value of CTA were evaluated. Results All the 15 patients were confirmed as intracranial aneurysms in the operation, which was essentially consistent with the preoperative diagnosis by CTA. The size and growth direction of the aneurysms were essentially consistent with the preoperative judgement, and all the aneurysms were clipped. The prognosis of the patients was assessed by the Glasgow Outcome Scale （GOS）. All the patients were followed up by the outpatient department and/or telephone for 6 to 78 months （mean 24 months）. The GOS score in 2 patients was 2, in 2 was 3, in 6 was 4, and in 5 was 5. Conclusion Head CTA can briefly and quickly identify the ruptured intracranial aneurysm caused intracerebral hematoma and provide intuitive three-dimensional morphology and anatomical localization of the aneurysms. It is helpful to hematoma evacuation and clipping of the aneurysms in emergency operation.